Skip to main content
Log in

Terrorismus – Eine neue Dimension des Polytraumas

Terrorism – a new dimension in trauma care

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Terrorism – a new dimension in trauma care Zusammenfassung

Bombenanschläge auf die Zivilbevölkerung sind primäre Instrumente des globalen Terrorismus. Angesichts der zunehmend realeren Bedrohungslage auch in Europa gilt es jederzeit vorbereitet zu sein auf die Erfordernisse einer hohen Anzahl von Verletzten und einer neuen Qualität von Verletzungsmustern infolge von Bombenexplosionen. Für die behandelnden Kliniken stellt dies eine außerordentliche große medizinische und logistische Herausforderung dar.

In der vorliegenden Übersichtsarbeit werden zunächst die Grundlagen der Entstehung von Explosionsverletzungen aufgezeigt. Im Anschluss werden die grundsätzlichen Prinzipien von Triage und Polytraumamanagement präsentiert, welche sich an den Vorgaben des ATLS® („advanced trauma life support“) und der DCS („damage control surgery“) orientieren.

Diese sowohl im militärischen als auch im zivilen Umfeld bewährten Behandlungskonzepte mit wiederholter Triage und Lagebeurteilung bilden die Grundlage für verbesserte Behandlungsergebnisse bei der Versorgung des Polytraumas nach terroristischen Bombenanschlägen.

Abstract

Bomb attacks on the civilian population are one of the primary instruments of global terrorism. Confronted as we are with the increasingly real threat in Europe too, we now have to be constantly prepared for the mass casualties and new injury patterns in trauma care that are caused by terrorist bombings. This is extraordinarily challenging, on both medical and logistical levels, for the hospitals involved.

In this review the basic mechanisms of blast injuries are clarified. In addition, the fundamental principles of triage and the management of multiple trauma are presented; these are oriented on ATLS® (advanced trauma life support) and DCS (damage control surgery) guidelines. These treatment concepts, which have proved their worth in both military and civilian environments, involve ongoing triage and constant situational assessment and are the basis of improved treatment results in the care of multiply traumatized victims of terrorist bombings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Aharonson-Daniel L, Klein Y, Peleg K (2006) Suicide Bombers Form a New Injury Profile. Ann Surg 244: 1018–1023

    Article  PubMed  Google Scholar 

  2. Almogy G, Belzberg H, Mintz Y et al. (2004) Suicide Bombing Attacks – Update and Modifications to the Protocol. Ann Surg 239: 295–303

    Article  PubMed  Google Scholar 

  3. Ashkenasy-Steuer G, Shamir M, Rivkind A et al. (2005) Clinical Review: The Israeli experience: conventional terrorism and critical care. Crit Care 9: 490–499

    Article  Google Scholar 

  4. Beekley AC, Starnes BW, Sebesta JA (2007) Lessons learned from Modern Military Surgery. Surg Clin N Am 87: 157–184

    Article  PubMed  Google Scholar 

  5. Cullis IG (2001) Blast waves and how they interact with structures. J R Army Med Corps 147: 16–26

    PubMed  CAS  Google Scholar 

  6. DePalma RG, Burris BG, Champion HR et al. (2005) Blast injuries. N Engl J Med 352:1335–1342

    Article  PubMed  CAS  Google Scholar 

  7. Frykberg ER, Tepas JJ (1988) Terrorist Bombings -- Lessons Learned From Belfast to Beirut. Ann Surg 208: 569–576

    Article  PubMed  CAS  Google Scholar 

  8. Gutierrez de Ceballos J P, Turegano-Fuentes F, Perez-Daias D et al. (2005) 11 March 2004: The terrorist bomb explosions in Madrid, Spain -- an analysis of the logistics, injuries sustained and clinical management of casulties treated at the closest hospital. Crit Care 9: 104–111

    Article  Google Scholar 

  9. Irwin RJ, Lerner MR, Bealer JF et al. (1997) Cardiopulmonary physiology of primary blast injury. J Trauma 43: 650–655

    Article  PubMed  CAS  Google Scholar 

  10. Katz E, Ofek B, Adler J et al. (1989) Primary blast injury after a bomb explosion in a civilian bus. Ann Surg 209: 484–488

    Article  PubMed  CAS  Google Scholar 

  11. Keel M, Trentz O (2005) Pathophysiology of polytrauma. Injury 36: 691–709

    Article  PubMed  Google Scholar 

  12. Kluger Y, Nimrod A, Biderman P et al. (2006) The Quinary (Vth) injury pattern of blast. J Em Management 4: 51–55

    Google Scholar 

  13. Leibovici D, Gofrit ON, Stein M et al. (1996) Blast injuries: bus versus open-air bombings -- a comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma 41: 1030–1035

    PubMed  CAS  Google Scholar 

  14. Leibovici D, Gofrit ON, Shapira SC (1999) Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med 34: 168–172

    Article  PubMed  CAS  Google Scholar 

  15. Mayo A, Kluger Y (2006) Terrorist bombing. World J Emerg Surg 1: 33

    Article  PubMed  Google Scholar 

  16. Mellor SG (2006) Military surgery in the 21th Century. J Royal Medical Service 92: 108--113

    Google Scholar 

  17. Pape HC, Aufm‘Kolk M, Paffrath T et al. (1993) Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion -- a cause of posttraumatic ARDS. J Trauma 34: 540–548

    PubMed  CAS  Google Scholar 

  18. Pape HC, Hildebrand F, Pertschy S et al. (2002) Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopaedic surgery. J Trauma 53(3): 452–461

    PubMed  Google Scholar 

  19. Paran H, Neufeld D, Shwartz I et al. (1996) Perforation of the terminal ileum induced by blast injury: delayed diagnosis or delayed perforation? J Trauma 40: 472–475

    PubMed  CAS  Google Scholar 

  20. Parker PJ (2006) Damage Control Surgery and Casualty evacuation: Techniques for Surgeons, lessons for Military Medical Planners. J R Army Med Corps 152: 202–211

    PubMed  Google Scholar 

  21. Rotondo MF, Schwab CW, Mc Gonigal MD (1993) Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35: 375–382

    Article  PubMed  CAS  Google Scholar 

  22. Sasser SM, Sattin RW, Hunt RC, Krohmer J (2006) Blast lung injury. Prehosp Emerg Care 10: 165–172

    Article  PubMed  Google Scholar 

  23. Schwab CW (2004) Introduction: damage control at the start of 21th century. Injury 35: 639–641

    Article  PubMed  CAS  Google Scholar 

  24. Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF (2000) Damage control: collective review. J Trauma 49: 969–978

    PubMed  CAS  Google Scholar 

  25. Stahel PF, Heyde CE, Wyrwich W, Ertel W (2005) Current concepts of polytrauma management. Eur J Trauma 31: 200–211

    Article  Google Scholar 

  26. Tager G, Rucholtz S, Waydhas C et al. (2005) Damage control orthopaedics in patients with multiple injuries is effective, time saving and safe. J Trauma 59: 408–415

    Google Scholar 

  27. Wong JM, Marsh D, Abu-Sitta G et al. (2006) Biological foreign body implantation in victims of the London July 7th suicide bombings. J Tauma 60: 402–404

    Google Scholar 

Download references

Interessenkonflikt

Die korrespondierenden Autoren geben an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Schwab.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schwab, R., Güsgen, C., Hentsch, S. et al. Terrorismus – Eine neue Dimension des Polytraumas. Chirurg 78, 902–909 (2007). https://doi.org/10.1007/s00104-007-1409-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-007-1409-2

Schlüsselwörter

Key words

Navigation